Provider Demographics
NPI:1952545147
Name:WOMEN'S HEALTHCARE PHYSICIANS
Entity Type:Organization
Organization Name:WOMEN'S HEALTHCARE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-262-3399
Mailing Address - Street 1:775 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6005
Mailing Address - Country:US
Mailing Address - Phone:239-262-3399
Mailing Address - Fax:239-261-1189
Practice Address - Street 1:8340 COLLIER BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3625
Practice Address - Country:US
Practice Address - Phone:239-262-3399
Practice Address - Fax:239-261-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0025809207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256337101Medicaid
FLK1123Medicare PIN